4) Case based OSCE along with Bloom's learning levels acheived .

 4) Case-based OSCE along with Bloom's learning levels achieved.

TODAYS OSCE:- 

Firstly it was in OP where I was assigned a case to be seen on an OP basis 

A young male patient was sitting outside opd waiting.

He had a history of falls from a bike 3 days ago and 

Had developed pain in the right side of chest and bilateral tmj joint

There was no history of loss of consciousness; seizures; ENT bleeding; bowel incontinence or bladder incontinence 

Not a known case of HTN; CAD;  DM ; CVA ; TB ; EPILEPSY 

ON EXAMINATION:- 

Respiratory rate:- 14 CPM 

RESPIRATORY EXAMINATION:- 

Inspection:- no scars ; sinuses ; engorged veins 

Palpation:- equivocal movement of all parts of the chest 

Percussion:- resonant note is heard all over 

Auscultation:- bilateral air entry present ; NORMAL VESICULAR BREATH SOUNDS ; 

DIAGNOSIS:- MUSCULOSKELETAL INJURY SECONDARY TO TRAUMA 

( no signs of pneumothorax) 

Plan:- 

1. reassurance 
2. TAB DOLO 650 mg Po /bd 
3. Review sos 

LEARNING POINTS:- 

Examination of the respiratory system 

An aid to reducing unnecessary investigations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1715093/

Then we forwarded to IPD CASES:- 

There in the ICU, I encountered a patient 

Who came c/o loss of speech for one month.

the patient was apparently asymptomatic till one month ago, then she was found in an unconscious state on the roadside then she was noticed by the attendees and was taken to the local hospital and treated by a local doctor for 3 daysand then taken to an outside hospital, where CT brain was done=>Ischemic stroke was diagnosed, weakness and loss of speech => after 3-4 days they were transferred to other hospital (financial constraints)=>stayed there for 10 days and her power recovered and speech has improved and was discharged => after  10 days patient power deteriorated with decrease speech and was brought to our hospital.

PAST HISTORY:- 

Known case of HTN AND ON AMLODIPINE 5 mg 

Not a known case of DM; CAD; Thyroid; TB; or asthma.

PERSONAL HISTORY:-

Diet - mixed 

Appetite- normal

Sleep - adequate 

Micturition:- Normal 

Addictions :- smoking occasional 

Allergic history:- No history of any kind of allergies to food/drugs

Family history:- no significant family history 

GENERAL EXAMINATION:- 

NO PALLOR ; ICTERUS; CLUBBING; CYANOSIS; ; LYMPHADENOPATHY ; EDEMA

TEMPERATURE:- AFEBRILE

PR:98 bpm ; irregularly irregular 

BP:100/60 mmHg @ 4ml/hr noradrenaline 

RR:28 cpm

GRBS:- 109 mg/dl

SYSTEMIC EXAMINATION:- 

CVS:S1 S2+,NO MURMURS

RS:BAE+ ; NVBS ; B/L BASAL CREPTS

P/A:SOFT ; NON TENDER ; NO ORGANOMEGALY 

CNS:- 

Tone 

       Right                     Left 

U.L   N.                           Increased

L.L.   N.                           Increased 

Power 

        Right   Left 

U.L    3/5.    3/5

L.L.    3/5.    3/5

Reflexes 

         Right     left 

B        ++.         ++

T.       ++.          ++

S.       -              - 

K.        ++.       ++ 

A.              -          -

PLANTAR:- flexor.    Extensor 

ALTERED SENSORIUM 2 to  CHRONIC ISCHEMIC  STROKE AT LEFT MCA TERRITORY  PERSISTENT, NON-VALVULAR ATRIAL FIBRILLATION WITH FVR  2 to CAD HEART FAILURE WITY PRESERVED EJECTION FRACTION 2' to CAD with HYPOKALEMIA  (Resolving)  WITH CARDIOGENIC SHOCK WITH HTN SINCE 4 years 

MANAGEMENT:- 

1. RT FEEDS - 4 Th hourly —- water / 4 Th hourly Milk 
2. INJ NORADRENALINE @4ml/hr IV INFUSION INCREASE OR DECREASE ACCORDING TO MAP; maintain MAP > 65 mmHg 
3. INJ HEPARIN IV/QID 
4. TAB ECOSPIRIN AV (75/20) RT /HS 
5. INJ AMIODARONE 6mg/ml @ 6.3 ml/hr 
6. SYP POTKLOR 15 ml in one glass of water 
7. Monitor vitals hourly.

INVESTIGATIONS DONE:- 

Questions asked in today’s posts:- 

Efficacy of amiodarone? In atrial fibrillation 

In amiodarone-treated patients (N = 1,107), freedom from recurrent atrial fibrillation was 84% and 45% at 1 and 5 years, respectively, with no differences according to left ventricular function (P = 0.8754).

Amiodarone's efficacy in maintaining sinus rhythm and reducing the burden of atrial fibrillation is similar in the presence or absence of severe left ventricular dysfunction. Rhythm control with amiodarone is associated with comparable hospitalization and mortality rates to rate control in patients with and without left ventricular dysfunction.

https://pubmed.ncbi.nlm.nih.gov/25181386/#:~:text=In%20amiodarone%2Dtreated%20patients%20(N,function%20(P%20% 

1. Remembering:- 

 

The basic history and sequence of events of the patient are remembered 

patient was apparently asymptomatic till one month ago, then she was found in an unconscious state while walking and was treated by a local doctor for 3 days and then taken to a outside hospital, where CT brain was done=>Ischemic stroke was diagnosed, weakness and loss of speech => after 3-4 days they were transferred to other hospital (financial constraints)=>stayed there for 10 days and her power recovered and speech has improved and was discharged => after  10 days patient power deteriorated with decrease speech and was brought to our hospital.

PAST HISTORY:- 

Known case of HTN AND ON AMLODIPINE 5 mg 

1. Understanding:- 

 Understanding the current problem of the patient 

And explained the ideas and concepts regarding the patient 

1. Applying

Based on the history of proper investigations

Hemogram; CUE ; serology

ECG ; CXR ; ultrasound 

CT SCAN is done

AND everything is applied to get a proper diagnosis of the patient.

https://www.researchgate.net/figure/Algorithm-on-how-to-approach-a-suspected-stroke-patient-From-Jauch-EC-Cucchiara-B_fig2_233767690

1. Analyzing

Based on all the above levels she has Been analyzed properly to get a proper diagnosis for which adequate treatment is being given.

LEARNING POINTS:- 

stroke symptoms 

https://www.cdc.gov/stroke/signs_symptoms.htm